Return to Sport in Athletes With Borderline Hip Dysplasia After Hip Arthroscopy for Femoroacetabular Impingement Syndrome

Abstract

Background: Data on outcomes in patients with borderline hip dysplasia (BHD) who undergo hip arthroscopy remain limited, particularly in regard to return to sport (RTS). Purpose: To evaluate outcomes in patients with BHD and their ability to RTS after hip arthroscopy for treatment of femoroacetabular impingement syndrome (FAIS). Study Design: Case series; Level of evidence, 4. Methods: Consecutive patients with self-reported athletic activity and radiographic evidence of BHD, characterized by a lateral femoral center-edge angle (LCEA) between 18° and 25° and a Tönnis angle >10°, who underwent hip arthroscopy for FAIS between November 2014 and March 2017 were identified. Patient characteristics and clinical outcomes including the Hip Outcome Score–Activities of Daily Living (HOS-ADL), Hip Outcome Score–Sports Subscale (HOS-SS), modified Harris Hip Score (mHHS), international Hip Outcome Tool (iHOT-12), and visual analog scale (VAS) for pain and satisfaction were analyzed at minimum 2-year follow-up. In addition, all patients completed an RTS survey. Results: A total of 41 patients with a mean age and body mass index (BMI) of 29.6 ± 13.4 years and 25.3 ± 5.6, respectively, were included. Mean LCEA and Tönnis angle for the study population were 22.7°± 1.8° and 13.3°± 2.9°, respectively. A total of 31 (75.6%) patients were able to RTS after hip arthroscopy at a mean of 8.3 ± 3.2 months. A total of 14 patients (45.2%) were able to RTS at the same level of activity, 16 patients (51.6%) returned to a lower level of activity, and only 1 (3.2%) patient returned to a higher level of activity. Of the 11 high school and collegiate athletes, 10 (90.9%) were able to RTS. All patients demonstrated significant improvements in all patient-reported outcome measures (PROMs) as well as in pain scores at a mean of 26.1 ± 5.4 months after surgery. Patients who were able to RTS had a lower preoperative BMI than patients who did not RTS. Analysis of minimum 2-year PROMs demonstrated better HOS-ADL, HOS-SS, mHHS, iHOT-12, and VAS outcomes for pain in patients able to RTS versus those who did not RTS ( P < .05). Conclusion: Of the patients with BHD studied here, 75.6% of patients successfully returned to sport at a mean of 8.3 ± 3.2 months after hip arthroscopy for FAIS. Of the patients who successfully returned to sport, 45.2% returned at the same level, and 3.2% returned at a higher activity level.

Outcomes and Return-to-Sports Rates in Patients With Borderline Hip Dysplasia After Periacetabular Osteotomy: A Case Series With 5-Year Follow-up

“…Although high return-to-sports rates have been reported after hip arthroscopic surgery in patients with BHD, 2,13,24 to our knowledge, no study to date has reported on return to sports and activity levels in patients with BHD after PAO. However, this information is essential to be able to counsel active patients in the choice of a surgical management strategy for BHD, as hip arthroscopic surgery and PAO are procedures of different magnitudes, which presumably could have implications in return to sports.…”

“…15,21 At the time of indication, regardless of the surgical approach chosen, patients are usually young and active with high functional demands. Those who participate in sports want to resume and maintain sports activities after surgery, 2,6,13,18,[23][24][25] and the ability to do so plays an important role in the choice of a treatment method.…”

Outcomes of Flexibility Sport Athletes With Borderline Hip Dysplasia After Hip Arthroscopy for Femoroacetabular Impingement Syndrome: A Propensity-Matched Analysis at Minimum 2-Year Follow-up

“…Patients with flexibility sport participation at the recreational, high school, collegiate, and professional level were deemed athletes and were eligible for study inclusion in accordance with previous literature. 1,17,33,47 Exclusion criteria were patients undergoing revision hip arthroscopy, pincer deformity (defined as an LCEA >40° 29 ), severe dysplasia (LCEA <18°), patients with a connective tissue disorder (eg, Ehlers-Danlos syndrome), patients undergoing a concomitant hip procedure (eg, gluteus medius/minimus repair), patients undergoing a staged periacetabular osteotomy (PAO), Tönnis grade >1 osteoarthritis, and those with a developmental hip disorder (eg, Legg-Calvé-Perthes disease or slipped capital femoral epiphysis). The included patients were compared with a propensity score–matched group of patients with normal coverage (LCEA ≥25° and <40°) who underwent primary hip arthroscopy for FAIS within the same time frame.…”

“…In cases in which cam impingement was present (defined as an alpha angle >50° on preoperative AP pelvic or 90° Dunn lateral radiograph and intraoperative evidence of femoroacetabular impingement on dynamic examination), femoroplasty was performed under direct arthroscopic and fluoroscopic guidance. 1,43 In cases of inadequate femoral neck exposure, the interportal capsulotomy was extended vertically to create a T-type capsulotomy. After femoroplasty, dynamic examination was performed to ensure joint congruency.…”

“…14 A standardized horizontal reference line was created by connecting a line through the inferior-most aspect of the ischium on each side of the pelvis. 1 A standardized vertical reference line was then created by making a line perpendicular to the standardized horizontal reference line. 1 Preoperative computed tomography scans were used to evaluate acetabular and femoral version based on previously described techniques.…”